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Deciaration of Domicile and Gitizenship
TO THE STATE AND COUNTY TAX ASSESSOR, 24~'1~I
_ ~
~ COUNTY, FLORIUA:
This is my declaration of
Domiciic and Citizenship in the State of Florida that I am fiiling this day in
aecordance, and in conformity wilh Section 2'2. l7, Florida Statutes.
1 wus formerty a lega! resident of _~i~.•-l~~ Y`L . _ and [
(citr) (state)
rc~sidec! st . However. I have changed my domicile to
(Street snd Number)
and am and have been a bona fide resident of the State of Florida since day of
- , 19_,Lt~, and I reside at 1~~?~- ~~+e.L~~
(Street and Number)
.
County, Florida,
(city>
and this statcmeni ss to be taken as my declaration of citizenship, actual legal residence and domicile in the State
ot' Florida.
(Inseri here any prriinrnl tacts, such as sale of property or business, or telinquishment of employment at former
domicile, removal of famity to new domicde, purchsse of home, rte.)
This is to establish that my daughter, THEODORA CRIST, a student is a resident
of this City, County and State.
,J
F~tEa ~~a ~~caAOfn ~
ST.lUC1E COUxTI' fLA.
~LERK~ER ~r~t~~s
RFPORt! ti~ t~JrT CcURT
r.. ~f~
~e ~ 8 So ap '~3
~ 24`~1s1
1 FURTHER CERTIFY that [ will register at my tocal address when the registration bovks reopen, and
comply with a11 other requirements of a legat resident oF this State.
` ~ 1•F.~IRTHER CERTIFY that ! have no intention to return to my former domicile, and I intend to remain in
. ~
.
: ~ ~/C`~-.~~ , County,
' ~]q~;~~e~tanently.
, ~ ~ =
' -.;Li C ~ = J~~ -
_ . ~ _ _LC~Y._az~~~
A~
' , - (Name) -
•'t•~.
.
~i~ ~ L ~ l L~. ~ ` ` _f--11__Y_(Q-_- v~.~- _
'~rru~,~~~ (Address)J ~
{ Sworn to and subscribed before me this day of
- A_D. 19-~~-
` ~ _
Notary u lic S!a of Florida al Large
A1y Commission expires~ ~ _~__Z~____
(To be rxrcuted in dupticate and original fJed with Clerk Circuit Court, and duplicate with Tax Assessor) ~
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